Requesting a Review from the Quality Improvement Organization

If you feel you are being discharged from a hospital stay before you are ready, you, as a Medicare beneficiary, have the right to ask for a review by the Quality Improvement Organization (QIO). 

To receive a review, you need to contact the Quality Improvement Organization as soon as possible, before you are discharged, and ask them for a fast review.  If you do, you will be able to stay past your discharge date without paying more than applicable coinsurance or deductibles until the QIO is able to make a decision.

Soon after you request the fast review from the QIO, they will notify the hospital.  The hospital will then give you a “Detailed Notice of Discharge”.  This notice explains why your stay is no longer necessary, the connected Medicare coverage rule, and how this rule applies to your situation.  The notice will be delivered to you no later than noon following the day of the QIO’s notification to your hospital.  The QIO will consider your medical information as well as your opinion (or that of your appointed representative), and decide if you are ready to be discharged on the date the hospital set for you.  They should reach their decision within one day after getting the necessary information.  

If the QIO rules in your favor, Medicare coverage will continue for your care services as long as necessary.  If the QIO rules against you, however, you will need to leave the hospital by noon the day after the QIO gives its decisions.  You will not be required to pay any hospital charges occurring before the new mandatory discharge time (outside of applicable coinsurance or deductibles).

The hospital will provide you with the QIO phone number.  You can contact them for more information, or call Medicare at 1-800-633-4227.

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